Insuficiencia respiratoria aguda, hipoxemia refractaria y ventilación mecánica. Una revisión sistemática.

Acute respiratory distress syndrome (ARDS) or also known as respiratory distress, is an interruption of homeostasis at the alveolar level that can promote: hypoventilation, deterioration of diffusion, shunt and mismatch between ventilation - perfusion or a combination of both. Refractory hypoxemia is defined as a partial blood oxygen pressure measured by blood gas (PaO2) 60 mmHg or a divided oxygen blood pressure ratio for the oxygen inspiratory fraction, PaO2/FiO2 or (PAFI) 100. Mechanical ventilation is a necessary life support measure in the treatment of severe acute respiratory failure. General Objective: To determine the ventilatory management of patients with acute respiratory failure and refractory hypoxemia. Specific objectives: To evaluate the use of ECMO in refractory hypoxemia 2) To determine the usefulness of non-invasive mechanical ventilation, oxygen therapy and adjuvant therapy. METHODS: a systematic review of the literature according to the PRISMA 2020 declaration was carried out with articles from the last 5 years in the vast majority. Databases such as academic Google, Pubmed, IntechOpen, Mendeley, ScienceDirect, journals: JAMA, BMJ, critical care, NEJM, respiratory care were consulted: randomized studies, multicenter studies, clinical cases, review articles, meta-analysis, systematic review, guidelines, observational, descriptive, retrospective studies and consensus documents on the topics: acute respiratory failure, refractory hypoxemia and mechanical ventilation. RESULTS: Position in a prone position is of great importance during distress, as is support with extracorporeal circulation membrane, neuromuscular block and corticosteroids in the treatment of ARDS. As for the ventilatory strategies in this group of patients, intubation is the first step, via translaringea and connection to invasive mechanical ventilation, after which, we can apply the following strategies to improve oxygenation: Use of low Vt in volume-controlled ventilatory modes, low plateau pressures <30 in controlled modes that minimize barotrauma and low FiO2, to prevent oxygen-free radical-related injuries. Current evidence supports use of tidal volume (Vt) lower 6 ml/kg. DISCUSSION: Mechanical ventilatory management of the critical patient with acute respiratory failure presenting refractory hypoxemia includes evaluating oxygenation by PaO2/FiO2. the primary objective is to achieve adequate airway pressure values, apply low Vt, maintain an adequate plateau pressure and measure the conduction pressure to titrate the PEEP at the lowest possible value. Pronation is vital to improve oxygenation and airway pressures. The results of this research showed that, there is benefit of mechanical ventilation with the use of ECMO in this group of patients, in addition, it was determined that high flow oxygen therapy only decreases hypoxemia before intubation, without altering mortality. Dexamethasone, if it provides benefit, as adjuvant therapy in the treatment of acute respiratory failure, with refractory hypoxemiaIntroducción: El síndrome de dificultad respiratoria aguda (SDRA) o también conocido como distress respiratorio, es una interrupción del homeostasis a nivel alveolar que puede promover: hipoventilación, deterioro de la difusión, derivación y desajuste entre la ventilación - perfusión o una combinación de ambas

Fibrinólisis intravenosa con alteplasa en un paciente joven con ictus isquémico agudo asociado a coartación de aorta

Regarding coarctation of the aorta, it is a rare congenital disease, in which a systemic arteriopathy occurs, caused by narrowing of the vessel, generating obstruction to the aortic flow, , this malformation, is very little related to acute ischemic stroke in young people, therefore, the objective is to present the case of a 26-year-old male patient with a clinical picture compatible with ischemic stroke secondary to coarctation of the aorta in the evaluation with thorax angiography and echocardiogram, enters window period ( 4.5 hours) and pharmacologic thrombolysis is performed with accelerated regimen with alteplase. It reviews bibliography of current scientific articles, studies , meta analysis and guides of the New York Heart Association and the American Stroke Association , articles mostly from 2020 onwards, obtained from internationally recognised databases such as PUBMED, JAMA, ELSEVIER, in a total of 21 articles in English and Spanish, concluding that, the coexistence of acute ischemic stroke associated with coarctation of the aorta is a rare occurrence in the young population and that it can be treated initially with intravenous infusion of alteplase as a thrombolysis method and that there are other therapeutic alternatives for correction of aortic coarctationRespecto a la  coartación de aorta, es una enfermedad congénita rara,  en la que,  se produce una arteriopatía sistémica, ocasionada por estrechamiento del vaso, generando obstrucción al flujo aórtico, , ésta malformacion,  es muy poco relacionada con el ictus isquemico agudo en los jovenes,  por lo que,  se plantea como objetivo  presentar  el caso de un paciente  masculino  de 26 años de edad con cuadro clinico compatible con  accidente cerebrovascular isquémico secundario a coartación de la aorta en la evaluación con angiotac de torax y ecocardiograma, ingresa en periodo de ventana ( 4.5 horas)  y se realiza  la trombolisis farmacologica con  regimen acelerado con alteplasa. Se realiza revision bibliografia de articulos cientificos actuales, estudios , meta analisis  y guias de la New York Heart Asociation y de  la American Stroke Association , artículos en su mayoría del año 2020 en adelante, obtenidos de bases de datos reconocidas a nivel internacional como PUBMED, JAMA,  ELSEVIER, en un total de 21 artículos en los idiomas inglés y español,  concluyéndose que,  la coexistencia de ictus isquémico agudo asociado a coartación de aorta es una rara ocurrencia en la población joven y que puede ser tratada inicialmente con  infusión intravenosa de alteplasa como método de  trombólisis y que existen otras alternativas terapéuticas para corrección de coartación de aorta

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines

Background: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, see Supplementary data) concluded the following: Results: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50–200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 7

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, volumen 7, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada de acceso abierto a todas las áreas del conocimiento, que cuenta con el esfuerzo de investigadores de varios países del mundo, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico que consoliden la transformación del conocimiento en diferentes escenarios, tanto organizacionales como universitarios, para el desarrollo de habilidades cognitivas del quehacer diario. La gestión del conocimiento es un camino para consolidar una plataforma en las empresas públicas o privadas, entidades educativas, organizaciones no gubernamentales, ya sea generando políticas para todas las jerarquías o un modelo de gestión para la administración, donde es fundamental articular el conocimiento, los trabajadores, directivos, el espacio de trabajo, hacia la creación de ambientes propicios para el desarrollo integral de las instituciones

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Génetica y genómica poblacional como herramientas de estudio antropológico en México. 6 (2018) septiembre-diciembre. Diario de Campo

- Introducción por Raúl Cuauhtémoc Baptista Rosas. - Antropología molecular y análisis del adn mitocondrial en poblaciones nahuas del Altiplano de México por Angélica González Oliver, Ernesto Garfias Morales, Víctor Hugo Avilés Chávez, Aurora Millán Sierra y Héctor Alessandro López Hernández. - La ruta de los yaquis desde Sonora hasta Yucatán: una propuesta de identificación histórico-biológica Oana del Castillo Chávez y José Manuel Arias López. - Heredabilidad de la obesidad en el noreste de México. Estudio basado en el índice de masa corporal de diadas (madre-hijo) por Ricardo M. Cerda-Flores, Andrés Figueroa y Hugo Leonid Gallardo-Blanco. - La inmunogenética más allá de la clínica: genes y patógenos que marcaron nuestra historia demográfica por Rodrigo Barquera Lozano. - ¿Dónde están los genomas de los mexicanos afrodescendientes? por Raúl Cuauhtémoc Baptista Rosas, Alma Aurora Arreola Cruz, Ana Sofía Torres Menchaca y Citlalli Quecha Reyna. - Genética y genómica de poblaciones en México. ¿Dónde estamos y hacia dónde vamos? Entrevista con Héctor Rangel Villalobos por Raúl Cuauhtémoc Baptista Rosas. - El reto de analizar genomas en México. Entrevista con Andrés Moreno Estrada por Raúl Cuauhtémoc Baptista Rosas. - Una última entrevista: el seguimiento molecular a una pieza ósea de un contexto prehispánico por Rodrigo Barquera Lozano. - La violencia implícita en la discriminación étnica y el papel de la lengua materna. Narrativas de mujeres mè’phàà y na savi de La Montaña de Guerrero por María Cristina Hernández Bernal. - Vinculación interinstitucional y peritaje antropofísico por Israel David Lara Barajas. - Análisis del desarrollo ontogenético en personas con trisomía 21: un enfoque comparativo por Bernardo Yáñez Macías Valadez. - Tres ediciones del Mexico Population Genetics Meeting (#mexpopgen). - Karla Sandoval Mendoza. - El cuerpo revisitado. Reseña crítica del libro: Arturo Rico Bovio (2017). Muerte y resurrección del cuerpo. México: Plaza y Valdés / Universidad Autónoma de Chihuahua por Elio Masferrer Kan